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Your Phone Number:
Your Email Address:
Name of Candidate for alleged violation:
Position of Candidate for alleged violation:
Speaker of the House
Date of alleged violation:
Time of alleged violation:
Location of alleged violation:
Detailed description of alleged violation:
Other witnesses of alleged violation:
I affirm the information provided in this report is accurate to the best of my knowledge, and will do all I can to answer any questions of the Elections Committee in order to provide further detail of the events if requested.
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